Optical coherence tomography criteria for defining functional severity of intermediate lesions: a comparative study with
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ORIGINAL PAPER
Optical coherence tomography criteria for defining functional severity of intermediate lesions: a comparative study with FFR Tomasz Pawlowski • Francesco Prati • Tomasz Kulawik • Eleonora Ficarra • Jacek Bil • Robert Gil
Received: 20 March 2013 / Accepted: 24 August 2013 / Published online: 3 September 2013 Ó Springer Science+Business Media Dordrecht 2013
Abstract Fractional flow reserve (FFR) is the gold standard in the assessment of severity of the coronary stenosis. The aim of the study was to compare optical coherence tomography (OCT) obtained intermediate coronary lesions lumen areas measurements with FFR assessments, with the goal to develop an OCT threshold to identify significant coronary stenosis. 48 patients (mean age 65 ± 10 years) was enrolled for the study. Within this population, 71 intermediate coronary lesions were investigated using both FFR and OCT. High dose bolus of Adenosine (120 lg) was used to obtain coronary hyperemia. OCT imaging was performed using non-occlusive technique to assess minimal lumen area (MLA) and diameter. The OCT cut-off value that showed the best correlation with the FFR cut-off of 0.80 was the MLA less than 2.05 mm2 (accuracy 87 %, sensitivity 75 %, specificity 90 %, p \ 0.001). The study did not disclose any relationship between FFR value and the lesion length. Vessel size influenced the OCT cut-off values, with greater values being found in presence of arteries with a reference diameter greater than 3.0 mm. OCT derived minimal lumen area might be complementary to FFR measurement in identifying ischemia related
T. Pawlowski (&) T. Kulawik J. Bil R. Gil Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland e-mail: [email protected] F. Prati E. Ficarra San Giovanni Hospital, CLI Foundation, Rome, Italy R. Gil Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
lesions. Further studies are warranted to assess threshold values in relation to vessel size and location. Keywords
OCT FFR Intermediate lesion
Introduction The assessment of stenosis severity in the presence of intermediate coronary lesion is mainly performed using fractional flow reserve (FFR), that provides a functional study of the target artery. Intravascular ultrasound (IVUS) [1, 2] or OCT [3] are alternative options offering morphological non-functional insights. Robust clinical data support the adoption of fractional flow reserve [4–6] that is nowadays the gold standard to decide whether to treat ambiguous lesions at angiography. Some operators however prefer to rely on IVUS or OCT as such technique also provide, during angioplasty, instrumental data on the adequacy of stent implantation in case of intervention [7]. These techniques are therefore applied as a surrogate of FFR to judge the severity of intermediate lesions. Some IVUS criteria have been adopted in the past to address the severity of intermediate lesions, including left main location [8–10] and a lumen area threshold of 4.0 mm2 was set to discriminate
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